Nursing 612 API Adult Gerontology at St Thomas University
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Free Nursing 612 API Adult Gerontology at St Thomas University Questions
John is 80 years old and is experiencing the following: weight gain, tachycardia, neck vein distention, and cognitive impairment. The nurse practitioner assesses for which of the following to support a diagnosis of heart failure? Select all that apply.
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Laterally displaced point of maximum impulse of apical pulse.
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Asymptomatic
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Rales in bilateral lower lobes not due to atelectasis or ascites.
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Increase in appetite and alertness.
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Functional impairment.
Explanation
The Correct Answers are:
A. Laterally displaced point of maximum impulse of apical pulse, C. Rales in bilateral lower lobes not due to atelectasis or ascites, and E. Functional impairment.
Detailed Explanations:
A. Laterally displaced point of maximum impulse of apical pulse:
A laterally displaced PMI occurs when the left ventricle enlarges due to volume overload or decreased contractility—both common findings in heart failure. It indicates ventricular dilation.
C. Rales in bilateral lower lobes not due to atelectasis or ascites:
Crackles (rales) in the lung bases result from pulmonary congestion and fluid accumulation caused by left-sided heart failure. These are hallmark findings indicating poor cardiac output and pulmonary venous hypertension.
E. Functional impairment:
Heart failure decreases exercise tolerance and daily functioning due to fatigue, dyspnea, and poor perfusion. This functional decline is a key clinical indicator, especially in older adults.
Devon visits the urgent care facility for sudden symptoms of pain to his lower extremity. The initial diagnosis is acute arterial ischemia. Aside from pain, which other symptoms may arise from this diagnosis? Select all that apply.
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Paresthesia
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Pulselessness
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Purulence
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Paralysis
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Pallor
Explanation
The Correct Answers are:
A. Paresthesia, B. Pulselessness, D. Paralysis, and E. Pallor.
Detailed Explanations:
A. Paresthesia:
A tingling or numb sensation occurs due to reduced blood flow and oxygen supply to peripheral nerves, an early sign of ischemia.
B. Pulselessness:
Absent or diminished peripheral pulses indicate a severe reduction or total loss of arterial blood flow, a hallmark sign of acute arterial occlusion.
D. Paralysis:
Muscle weakness or inability to move the affected limb may develop as ischemia progresses and nerve and muscle tissues become deprived of oxygen.
E. Pallor:
The affected limb appears pale or ashen due to lack of arterial perfusion. This can progress to mottling and cyanosis if circulation is not restored.
In the initial screening for a diagnosis of AAA, which of the following is the best screening test?
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Ultrasound in the abdominal area
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Complete blood count (CBC)
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Angiography
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CT scan
Explanation
The Correct Answer is:
A. Ultrasound in the abdominal area.
Detailed Explanation:
Abdominal ultrasound is the preferred initial screening test for an abdominal aortic aneurysm (AAA) because it is noninvasive, safe, inexpensive, and highly accurate in detecting the presence and size of an aneurysm. It allows visualization of the aorta and precise measurement of its diameter.
While a CT scan provides detailed anatomical information and is used for preoperative evaluation or when rupture is suspected, it is not the first-line screening tool. Angiography is invasive and used for surgical planning, and a CBC is not diagnostic for AAA. Therefore, abdominal ultrasound is the best choice for initial detection and population screening, especially in older adults and smokers.
Treatment to slow the progression of PAD should include which of the following? Select all that apply.
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Conservative
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Surgical
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Pharmacological
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Heat
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Immobilization
Explanation
The Correct Answers are:
A. Conservative, B. Surgical, and C. Pharmacological.
Detailed Explanations:
A. Conservative:
Conservative management is the first-line approach for peripheral arterial disease (PAD). It includes lifestyle modifications such as smoking cessation, regular exercise (especially walking programs), weight control, and a heart-healthy diet. These interventions improve circulation and slow disease progression.
B. Surgical:
Surgical or interventional procedures, such as angioplasty, stent placement, or bypass grafting, are used in severe cases to restore adequate blood flow when conservative and medical therapies are insufficient.
C. Pharmacological:
Medications such as antiplatelet agents (aspirin or clopidogrel), statins, and cilostazol help improve blood flow, prevent clot formation, and reduce atherosclerotic progression.
Ms. Alma, 69 years old, seeks medical advice because she is having trouble breathing. She is experiencing dyspnea, chronic cough with sputum production, and decreased activity tolerance. The nurse practitioner suggests which of the following? Select all that apply.
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The body contains less water as you age, and the mucus begins to dry out.
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As you get older, the tissue in your lungs is not as flexible to aid in exhaling.
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The muscles that help to inhale become stronger as you age.
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The cough reflex is normal, but the mucus is too thick.
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As you get older, there is an increase in the exchange of gases between the lungs and the blood vessels.
Explanation
The Correct Answers are:
A. The body contains less water as you age, and the mucus begins to dry out; B. As you get older, the tissue in your lungs is not as flexible to aid in exhaling; and D. The cough reflex is normal, but the mucus is too thick.
Detailed Explanations:
A. The body contains less water as you age, and the mucus begins to dry out:
With aging, total body water decreases, leading to thicker mucus that is harder to expel. This contributes to chronic cough and ineffective airway clearance.
B. As you get older, the tissue in your lungs is not as flexible to aid in exhaling:
Elastic tissue in the lungs loses its flexibility with age, causing reduced recoil and air trapping. This makes it harder to exhale completely and leads to shortness of breath.
D. The cough reflex is normal, but the mucus is too thick:
Although the cough reflex remains intact, thicker mucus is more difficult to clear, reducing the effectiveness of coughing and increasing the risk of airway obstruction or infection.
Patient education is very important for individuals who have AAA. The patient and their family should be taught the importance of follow-up and the management of which of the following? Select all that apply.
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Chondromalacia
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Pain
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Smoking
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Hypertension
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Hypercholesterolemia
Explanation
The Correct Answers are:
B. Pain, C. Smoking, D. Hypertension, and E. Hypercholesterolemia.
Detailed Explanations:
B. Pain:
Pain may indicate aneurysm expansion or impending rupture. Patients should be taught to report new, persistent, or severe abdominal or back pain immediately, as this may signify a medical emergency.
C. Smoking:
Smoking accelerates atherosclerosis, damages vascular walls, and increases aneurysm growth and rupture risk. Complete smoking cessation is crucial to slow aneurysm progression and improve vascular health.
D. Hypertension:
Uncontrolled blood pressure raises wall tension in the aorta, significantly increasing the risk of aneurysm rupture. Strict blood pressure control through medication and lifestyle modification is essential for safety.
E. Hypercholesterolemia:
Elevated cholesterol contributes to atherosclerosis, the underlying cause of most abdominal aortic aneurysms. Managing cholesterol through diet, exercise, and medication helps reduce vascular inflammation and aneurysm progression.
AAA is mostly atherosclerotic in nature, but can also be caused by trauma, infection, and inflammation. Which of the following is a true statement regarding the tendency to develop AAA? Select all that apply.
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AAA is the 13th leading cause of death in the United States.
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There is no dominant ethnic group that develops AAA.
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Caucasians have a higher risk of developing AAA
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Women have a higher risk of developing AAA.
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There is a familial history associated with AAA development.
Explanation
The Correct Answers are:
A. AAA is the 13th leading cause of death in the United States, C. Caucasians have a higher risk of developing AAA, and E. There is a familial history associated with AAA development.
Detailed Explanations:
A. AAA is the 13th leading cause of death in the United States:
Abdominal aortic aneurysm (AAA) is a significant cause of mortality, particularly among older adults. Ruptured AAAs have a high fatality rate, making it one of the leading causes of sudden death in men over 65.
C. Caucasians have a higher risk of developing AAA:
Epidemiological data show that Caucasian men are at a notably higher risk compared to other ethnic groups. The condition is also more prevalent among individuals with a history of smoking and hypertension.
E. There is a familial history associated with AAA development:
A family history of AAA increases risk due to genetic predisposition affecting connective tissue integrity and vascular elasticity. First-degree relatives of affected individuals should undergo screening.
Ms. Alma, 69 years old, seeks medical advice because she is having trouble breathing. She is experiencing dyspnea, chronic cough with sputum production, decreased activity tolerance, and wheezing. She states that she had not been near anyone with any upper respiratory infections and wonders why this is happening. The nurse practitioner asks which of the following questions? Select all that apply.
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Have you ever worked in a factory or foundry?
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Have you ever smoked cigarettes?
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Have your symptoms increased as you've gotten older?
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How long have you experienced these symptoms?
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Do you have any past history of respiratory difficulties?
Explanation
The Correct Answers are:
A. Have you ever worked in a factory or foundry?, B. Have you ever smoked cigarettes?, C. Have your symptoms increased as you've gotten older?, D. How long have you experienced these symptoms?, and E. Do you have any past history of respiratory difficulties?
Detailed Explanations:
A. Have you ever worked in a factory or foundry?
Occupational exposure to dust, chemicals, and fumes is a significant risk factor for chronic obstructive pulmonary disease (COPD) and other chronic lung conditions.
B. Have you ever smoked cigarettes?
Smoking is the leading cause of COPD and chronic bronchitis. Assessing smoking history helps establish the most likely etiology for her symptoms.
C. Have your symptoms increased as you've gotten older?
Progressive worsening with age supports a chronic disease process such as COPD, rather than an acute infection.
D. How long have you experienced these symptoms?
Duration helps distinguish between acute respiratory infections and chronic respiratory diseases. Longstanding symptoms indicate a chronic underlying problem.
E. Do you have any past history of respiratory difficulties?
A prior history of respiratory illnesses such as asthma, bronchitis, or pneumonia provides context for current symptoms and helps guide diagnosis and management.
Mr. Borden is 79 years old and lives with his daughter. The daughter provides excellent care for her father and wants to know which changes in his heart and circulatory system are due to aging and which are due to lifestyle choices. The nurse practitioner replies:
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The size of the heart increases with age.
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The activity of the heart decreases in its ability to deal with stress, as well as to provide physical strength as one ages.
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The left ventricle hypertrophies in response to increasing in age.
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The patient’s diet affects the ability of the heart to balance blood pressure.
Explanation
The Correct Answer is:
B. The activity of the heart decreases in its ability to deal with stress, as well as to provide physical strength as one ages.
Detailed Explanation:
With normal aging, the cardiac reserve—the heart’s ability to increase output during stress, illness, or physical exertion—declines. This occurs due to decreased myocardial contractility, reduced responsiveness to catecholamines, and increased stiffness of the myocardium and arteries. As a result, older adults experience reduced tolerance for activity and slower recovery from physical or emotional stress. This diminished function is a natural part of aging, not necessarily caused by poor health habits.
Mrs. Prentiss is diagnosed with symptomatic AAA. The initial treatment is aggressive blood pressure control. At which of the following readings should mean arterial pressure be maintained?
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Between 80 and 100 mm Hg.
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Between 60 and 70 mm Hg.
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Between 90 and 120 mm Hg.
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Between 100 and 120 mm Hg.
Explanation
The Correct Answer is:
A. Between 80 and 100 mm Hg.
Detailed Explanation:
For patients with symptomatic abdominal aortic aneurysm (AAA), careful blood pressure control is critical to reduce aortic wall stress and prevent rupture. The mean arterial pressure (MAP) should be maintained between 80 and 100 mm Hg to ensure adequate organ perfusion while minimizing pressure on the aneurysm wall. Lower pressures (60–70 mm Hg) risk inadequate perfusion to vital organs, while higher levels (above 100 mm Hg) increase the chance of aneurysm expansion or rupture. Continuous arterial monitoring and IV antihypertensives, such as nicardipine or esmolol, are typically used to maintain this range safely.
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